Management of Bowel Perforation by Shunt Catheters in Children
12 cases in 10 years: The author has seen 12 such cases over a 10-year period where there was neither evidence of cellulitis along the shunt tract nor evidence of peritonitis.
Broad-spectrum antibiotics: The patients were given a combination of vancomycin, cefotaxime, and metronidazole and observed closely.
No laparotomy: None of the patients underwent a laparotomy for treatment of the suspected perforated bowel, and none developed signs or symptoms of peritonitis during this period. In one case, general surgeons proceeded to explore the abdomen but were unable to identify the site of perforation.
Omentum isolates injury: The author theorizes that as the catheter gradually erodes through the bowel wall, the omentum seals itself around the area, preventing spread of the focal inflammatory process to the peritoneal cavity. Once the catheter is pulled away, trying to locate this tiny slit covered with omentum can prove futile.